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Medical & Military Malpractice: The U.S. Public Health Service in Guatemala

In the 1940s U.S. Public Health medical researchers conducted appalling experiments on vulnerable populations in Guatemala. After last week's convening of President Obama's Commission for the Study of Bioethical Issues, the revelations are back in the news.

In the 1940s U.S. Public Health Service medical science researchers conducted appalling experiments on vulnerable populations in Guatemala. The revelations are back in the news.

[Bacteriologist, 1942. USPHS, www.memory.loc.gov]This dark episode made headlines last year when medical historian Dr. Susan Reverby’s research revelations prompted an official apology from President Obama to the government and people of Guatemala. Secretary of State Hillary Clinton and Secretary of Health and Human Services Kathleen Sebelius called the experiments“clearly unethical.”

One outcome of these public revelations was a lawsuit filed by Guatemalan survivors against U.S. federal health officials after the administration refused to set up an out-of-court claims process. Another outcome was an investigation into the research by the President’s Commission for the Study of Bioethical Issues. It was the final of a series of meetings conducted by these commissioners last week that brought the story back into the public spotlight—although it was interesting to see that this “hidden” history had not in fact always been so hidden. A recent New York Times article included a link to its 1947 coverage which highlighted the ethical obstacles and apparently prompted greater secrecy from the scientists involved: “The case holds good for rabbits, but no tests on human beings have yet been made. To settle the human issue quickly it would be necessary to shoot living syphilis germs into human bodies . . . since this is ethically impossible it may take years to gather the information needed.” In fact when the reporter wrote this, the experiments in Guatemala were already underway, and the researchers deliberately went on to infect over a thousand people with syphilis (and gonorrhea and chancroid) and then failed to provide follow up treatment or a cure to many of them. [History of Medicine, NIH, www.ihm.nlm.nih.gov]The statistics on the human fallout are shaky since the people chosen as human guinea pigs were locked up in prisons, insane asylums, and children’s orphanages, or were brought to prostitute themselves there. However, it is grimly estimated that some 5,500 people participated, at least 1,300 of them were infected with venereal diseases, at least 600 of those went untreated and almost 100 died.

A report on the Commission’s findings is scheduled for release this month. Discussion at the Commission’s meetings revealed a horrified consensus at the callousness and disregard for humanity exhibited by the scientists involved. These government researchers failed by even the minimal standards of the day to protect the health and well-being of the human test subjects, and did not inform them of the risks or gain consent for their participation. The Chair of the Commission, Dr. Amy Gutman, captured this sentiment as she described her effort to come to terms with what might have motivated the researchers to behave as they did: “I kept asking the question, ‘How could they do this?’ . . . My conclusion is, and it has to be a reluctant one: . . . the doctors did not treat these human beings as if they were worthy of respect or consideration.”

There has been much valuable commentary on how to morally and ethically respond to these revelations, not least of which includes an international review of medical research protocols around the world and the recognition that poor and vulnerable populations, particularly in the Global South, continue to be disproportionately exposed to dangerous clinical trials without adequate treatment and follow-up.

I wanted to draw attention to a couple aspects of this story that have received less attention. First, this history speaks to the relationship between the military and drug research and development. The purpose of these experiments was centrally tied to military priorities: to perfect a penicillin treatment for sexually transmitted diseases for affected soldiers (not for the women they themselves might infect—contemporary military propaganda campaigns depcited the threat as unidirectional, wayward women exposing fighting men.) As the World War II Medical Research Center describes, the Army lost the healthy bodies of thousands of enlisted men to sexually transmitted diseases. [History of Medicine, NIH, www.ihm.nlm.nih.gov]Moreover, the military had distributed prophylaxis kits to servicemen to try to limit infections but the kits were painful to use and the U.S. Public Health Service was hoping “less noxious chemicals or penicillin could be used instead.”

And so, the U.S. health officials and research scientists turned to human subjects—first a group of prisoners in Terre Haute, Indiana (who technically were asked for their consent) and then, they moved to Guatemala. Dr. Rerverby explains the rational for targeting imprisoned populations for medical research: these orphans, inmates, prostitutes and patients comprised in the eyes of the scientists, and the institutions funding them, the “available and contained.” They were not valued for their intrinsic humanity but rather as guinea pigs in experiments whose benefits would accrue to others and which, in certain instances, resulted in their own demise. It is a twisted example of how destructive U.S. military priorities can be to populations around the world who have not only been targeted by bombs but also to the devastating consequences of pharmaceutical drug developments that they themselves may never have access to or be able to afford. The scientists seemed not to consider these people potential beneficiaries of the wonders of science they were deriving from experiments on their very human bodies.

There is another aspect to the story that is in a way peripheral, but still disquieting. The U.S. government has received steady criticism for expanding government secrecy. Yet, in relation to these torturous experiments in Guatemala in the 1940s there has been a striking willingness to publicly reveal a lot: government investigations, high official diplomacy and commentary, government reports detailing the minutiae of the observations recorded by researchers (whose research never went through peer review, nor, it seems until now, was published.) Why the sudden openness? Part of it is simply the shock-value inherent to the historical revelations, perhaps to pre-empt the inevitable outcry. But there is something more sinister at play. This spring the National Archives released documentation of the experiment to the public. As someone who has researched at the National Archives and has enormous respect for its collections, the people who work there, and the necessity of government openness, I think declassification and increased access to information about the government’s activities is necessary and welcome. But why digitize the entire record of these experiments and make them available over the Internet? Out of curiosity I clicked on one of the links only to realize that these are case files with very personal and graphic information about what is hard not to understand as anything but torture. There is an effort to conceal the identity of patients with bars across their eyes, but the fact of personal intrusion at the time and as a viewer of the photographs cannot but be ugly and apparent. It seems almost voyeuristic, or pornographic (they were testing the sexual transmission of diseases), in a way that exploits the victims all over again.